Overactive Bladder Symptom Score Score Research Articles

P-02-51 Add-On Treatment With Mirabegron in Men With Benign Prostatic Hyperplasia Complaining Persistent Storage Symtoms after Tamsulosin Monotherapy Improves Quality of Life

Persistent storage symptoms after medication with alpha blocker decrease quality of life (QoL) and may disturb sexual activity. Therefore, we evaluated the effect of add on therapy with mirabegron in patient with benign prostatic hyperplasia (BPH) and persistent storage symptoms after treatment with tamsulosin. We evaluated International prostatic symptom score (IPSS), overactive bladder symptom score (OABSS), PSA, prostate volume (PV), maximum flow rate (Qmax), post voided volume (PVR) before and after treatment. Patients showing baseline OABSS question 3 ≥ 4 was included in this study and treat with tamsulosin 0.2 mg as an initial drug for 1 month. After 1 month, add-on treatment with solifenacin 5 mg or mirabegron 50 mg was done to the patients who did not show improvement of OABSS scores with tamsulosin 0.2 mg. Two months later we evaluated the changes of OABSS, IPSS, Qmax and PVR. After combination treatment for 2 months, there were no significant differences of IPSS scores between the patients received add-on treatment with solifenacin and mirabegron. However, improvement of IPSS QoL score of the patients treated with mirabegron and tamsulosin (3.64±1.55) compared with solifenacin and tamsulosin (4.25±0.71).

Exploring pelvic floor muscle activity in men with lower urinary tract symptoms.

AimWe aimed to explore the utility of the Multiple Array Probe Leiden (MAPLe) device to assess pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS).MethodsThis was an observational cohort study performed at the urology outpatient department of a large teaching hospital in the Netherlands between April and October 2018. We recruited male patients referred for the assessment of LUTS, without a history of prostate surgery, if they had an International Prostate Symptom Score greater than or equal to 8. The MAPLe device was then used to assess the puborectalis, pubococcygeus, iliococcygeus, urogenital diaphragm, and the internal and external anal sphincters during three tasks: a rest period (1 minute), five maximum voluntary contractions (held for 3 seconds each), and three maximal endurance contractions (held for 15 seconds each).ResultsIn total, 57 patients were included, 5 of which had diabetes mellitus. Muscle activity at rest was significantly lower than during either contraction task and did not differ between the muscle groups. By contrast, the external anal sphincter had significantly less activity than any other muscle group during the endurance task, and the internal anal sphincter and puborectalis had significantly less activity during the maximum voluntary contraction task. No association was found between pelvic floor muscle activity and LUTS severity during any task.ConclusionPelvic floor muscle activity and LUTS severity appear to be unrelated, but this does not completely exclude the possibility of muscle involvement in the development or experience of symptoms. Further research is needed.

Urodynamic classification of male patients with symptoms of overactive bladder and the outcome classification

OBJECTIVE To introduce a urodynamic classification of male patients with symptoms of overactive bladder (OAB) and discuss its clinical significance in practice. METHODS From January 2015 to January 2017, there were 181 male patients from Peking University People's Hospital who were diagnosed clinically with OAB and underwent preoperative urodynamic test. Finally 126 male patients were enrolled in the research. Male OAB patients could be stratified into four groups based on the chief complaints (whether or not presenting urgency) and the results of urodynamic test (whether or not presenting detrusor overactivity and the ability to stop the involuntary contraction). The contents of this follow-up study included the basic information, the preoperative and postoperative scores of the OAB symptom score (OABSS), the preoperative and postoperative scores of the international prostate symptom score (IPSS), and the amount of the concomitant diseases. RESULTS According to the classification, the amounts of the four types of OAB patients were 32 (25.40%) for type I, 27 (21.43%) for type II, 59 (46.83%) for type III, and 8 (6.35%) for type IV, respectively. The data of their heights showed no statistical significance (P>0.05). The ages, weights and the amount of the concomitant diseases of type IV were obviously higher than those of the other three types (P 0.05). The improvement of the OABSS and IPSS scores of the type IV were obviously inferior to the other three types (P 0.05). CONCLUSION Type IV has the worst outcome and type III has the best among the four types of OAB. And this classification system will certainly have a profound significance in guiding and directing our clinical diagnosis and treatments, and evaluating the prognosis of the patients with OAB.

Effects of tamsulosin hydrochloride sustained release capsule in improving symptoms and quality of life of patients with indwelling double-J ureteral stents

Objective To investigate the influence of tamsulosin hydrochloride sustained release capsule in improving symptoms and quality of life of patients with indwelling double-J ureteral stents. Methods From March 2016 to June 2017, 96 patients with indwelling double-J ureteral catheter were randomly divided into control group and observation group, with 48 patients in each group. The control group did not take drugs after operation, and the patients in the observation group were treated with tamsulosin hydrochloride sustained release capsule once a day, totally for 1 month. All the enrolled patients completed the Ureteral Stent Symptom Questionnaire (USSQ), the International Prostate Symptom Score (IPSS) , quality of life (QOL), visual analogue scale (VAS) as well as the Overactive Bladder Symptom Score (OABSS) on the day after the removal of the stent 4 weeks after treatment. Results The mean urinary symptom index score, the pain index score, the sex index score and the ability index of work score of the observation group were (25.23±4.35), (14.58±2.84), (3.82±1.03) and (12.83±3.85) , lower than the score (31.29±4.48), (30.39±3.91), (5.83±1.94) and (18.81±5.03) of the control group. The storage stage score and IPSS total score were respectively (3.31±1.38) and (6.87±2.94), lower than the score (6.14±2.03) and (10.31±2.26) of the control group. The QOL, VAS, OABSS score were (1.54±0.93 ), (1.95±1.07) and (4.31±1.28), lower than the score(3.24±0.93), (4.04±1.23) and (9.29±2.87) of the control group. As opposed to the control group, it was observed that observation group prominently improved and the scores were statistically significant(P<0.05). Conclusions Tamsulosin hydrochloride sustained release capsule can significantly improve the related symptoms of indwelling double-J ureteral stents and prostatic symptoms, reduce pain, improve patient's quality of life. Key words: Urinary Catheterization; Adrenergic alpha-Antagonists; Signs and Symptoms; Quality of Life

Epidemic investigation of benign prostatic obstruction with coexisting overactive bladder in Shanghai Pudong New Area and its impact on the health-related quality of life

BackgroundWe aimed to investigate the prevalence, relative risk factors, and the impact on the health-related quality of life (HRQoL) of benign prostatic obstruction (BPO) with coexisting overactive bladder (OAB) in men aged over 50 and living in Shanghai Pudong New Area.MethodsUsing a multi-stage sampling and descriptive epidemiological method, 1632 men were selected from among the general population. Participants completed an evaluation of lower urinary tracts symptoms (LUTS), including international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire. In addition, the Overactive Bladder Symptom Score (OABSS) and King’s health questionnaire (KHQ) were used to assess the impact of BPO with coexisting OAB on the HRQoL. Maximum flow rate (Qmax), postvoid residual urine volume (PVR) and prostate-specific antigen (PSA) were also recorded.ResultsA total of 1476 men with complete data were analyzed. The overall prevalence of BPO with coexisting OAB was 39.6%. Age and prostate volume were associated risk factors for BPO with coexisting OAB. In addition, BPO with coexisting OAB negatively impacted the HRQoL, with increased IPSS, QoL, OABSS, and KHQ scores and decreased IIEF-5 scores compared to that in patients with BPO without OAB.ConclusionsQmax, PVR and serum PSA did not predict whether the patients had a combined BPO + OAB or not. The prostate volume and age were associated risk factors for BPO with coexisting OAB. BPO is a progressive disease and may be one of the risk factors for OAB.

Reliability of the Polish version of the Overactive Bladder Symptom Score (OABSS) questionnaire

Introduction and hypothesisOveractive bladder (OAB) and mixed urinary incontinence (MUI) are significant problems worldwide. Their broad definition makes them difficult to diagnose; therefore, specialists need a tool to confirm diagnosis. The Overactive Bladder Symptom Score (OABSS) is used in the objective diagnosis of OAB. We aimed to develop and evaluate the effectiveness of OABSS for patients in Poland suffering from OAB and MUI and to correlate it with UDI-6 and IIQ-7.MethodsA total of 824 women suffering from urinary incontinence (UI) aged between 18 and 75 years were included. SUI (n = 290); OAB (n = 285) and MUI (n = 249) were confirmed by medical history and urodynamic study. Of the subjects, 821 women completed the Polish version of OABSS on two separate visits: weeks 0 and 2. In addition, they undertook UDI-6 and IIQ-7 during Week 2. The Cronbach’s alpha (α) was used to estimate the internal consistency. Scores were compared using the intraclass correlation coefficient (ICC).ResultsWe observed statistically significant differences (p < 0.0005) between mean scores of OABSS among patients from the study groups OAB-SUI and MUI-SUI. We did not observe statistically significant differences between patients from the MUI and OAB groups (p > 0.11). Analysis also did not show statistically significant differences between visits.The internal consistency was very good: α = 0.89 (SUI); = 0.9 (OAB); = 0.82 (MUI). In all groups, test–retest reliability was excellent; ICC was >0.99.ConclusionsThe Polish version of the OABSS is a reliable tool for females suffering from UI. However, OABSS does not distinguish patients with MUI from patients with OAB.

Turkish validation of the overactive bladder symptom score (OABSS) and evaluation of mirabegron treatment response.

Overactive bladder (OAB) is a syndrome with symptoms such as urinary frequency, urinary urgency and urge incontinence. The aim of this study is to assess the validity and reliability of the Turkish overactive bladder symptom score (OABSS) and to evaluate the results of mirabegron treatment with OABSS. The study was carried out with 117 patients who applied to the urology outpatient clinic between June 2018-January 2019. OABSS Turkish validation was developed from the English version. Demographic data of the patients were recorded. The OABSS, overactive bladder questionnaire (OAB-v8) and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) were filled out by the patients. The patients were asked to fill in these questionnaires after 2weeks. Patients receiving mirabegon treatment were evaluated with the same questionnaires and bladder diaries after 8weeks. A total of 117 OAB patients, including 82 OAB-wet and 35-OAB dry, were included in the study. The mean age of the patients was 46.79 ± 14.26 (18-78) years, and the mean duration of OAB complaint was 32.28 ± 32.21months. The mean score of the OABSS is 9.9 ± 3.14. The results of the reliability assessment showed that the intraclass correlation coefficient of the total OABSS score was 0.71 (weighted coefficients of individual item points, 0.635-0.831), and the Cronbach α was 0.736. In the validity analysis, the OABSS total score was highly correlated with that belonging to other questionnaire forms (OAB-v8, ICIQ-SF and bladder diary). After the treatment with mirabegron, mean OABSS scores of the patients improved significantly from baseline to the 8th week (p < 0.001). The Turkish version of the OABSS has been approved as a valid and reliable tool for evaluating OAB. Mirabegron used daily improved the symptoms of OAB in patients.

The clinical study of five-step sequential method for the treatment of hemorrhagic radiation cystitis

Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis. Methods From April 2015 to April 2018, 512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed. 12 cases were male patients, and 497 cases were female. Patients' average age was (60.1 ±8.2) years (53-71 years). Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years). According to the severity of hematuria, 480 patients were classified as mild and 32 patients as severe. The step 1 was drug conservative symptomatic treatment. Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral electrocoagulation.The step 4 was interventional embolization. The step 5 was hyperbaric oxygen therapy. Mild patients were treated from the first step, and the severe patients were treated from step 3, and combined with step 1. Overactive bladder symptom score (OABSS) was used to assess the improvement of patients' symptoms. Results No obvious complications occurred in step 1, 2, 3, 5. Mild hip pain occurred at step 4. Recurrent hemorrhage rate were 6.7%(2/30)in mild patients group and 10.5%(2/19)in severe respectively in step 4. The total effective rate of step 1 in mild patients group was 65.2%(313/480), step 1+ 2 was 84.2%(404/480), step 1+ 2+ 3 was 95.6% (459/480), step 1+ 2+ 3+ 4 was 98.3% (472/480), and step 1+ 2+ 3+ 4 + 5 was 100%(480/480). The effective rate of step 3+ 1 treatment was 59.4%(19/32)in severe patients group, step 3+ 1+ 4 was 68.8%(22/32), and step 3+ 1+ 4+ 5 was 100%(32/32). The OABSS scores of mild and severe patients decreased after treatment(P<0.01). Conclusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis. Key words: Radioactive cystitis; Transurethral electrocoagulation; Intervene embolize therapy; Hyperbaric oxygen

Effect of combined solifenacin and aclatonium in preventing dry mouth in patients with overactive bladder.

The aim of the present study was to prospectively evaluate the effect of aclatonium on dry mouth in patients with overactive bladder (OAB) after treatment with solifenacin. A multicenter randomized double-blind controlled trial was conducted. The study subjects were men and women who had been diagnosed with OAB for ≥3 months and presented with a total Overactive Bladder Symptom Score (OABSS) ≥3. Eligible subjects were randomized to receive 5 mg solifenacin with placebo or 5 mg solifenacin with 150 mg aclatonium once daily for 8 weeks. Subjects rated dry mouth using a visual analog scale (VAS) and completed the OAB-questionnaire (OAB-q) short form (SF) and OABSS questionnaires at baseline and after 8 weeks treatment. Dry mouth was defined as a VAS score >30 points (range 0-100). Overall, 92 patients (49 and 43 in the placebo and aclatonium groups, respectively) completed the 8-week treatment. In patients who had dry mouth at baseline, no differences were detected in changes in the dry mouth VAS, OABSS, or OAB-q SF scores between the 2 groups. However, in patients who had no dry mouth at baseline, the change in dry mouth VAS score was significantly lower in the aclatonium- than placebo-treated group: the VAS score increased 20 points in the placebo group compared with 9 points in the aclatonium group (P = .03). However, there were no significant differences in changes in the OABSS and OAB-q SF scores between the 2 groups. Aclatonium decreased dry mouth without disturbing treatment efficacy in patients who did not have dry mouth before treatment.

Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer's disease patients with lower urinary tract symptom.

ABSTRACTPurpose To examine an association between the overactive bladder symptom score (OABSS) and neuropsychological parameters. Moreover, we investigate the factors that affect each item in the questionnaire.Materials and Methods A total of 376 patients (males: 184; females: 192) with probable Alzheimer’s disease (AD) were recruited. Cognitive testing was conducted using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL). Lower urinary tract symptom (LUTS) was assessed using OABSS and voiding diary.Results The prevalence of overactive bladder (OAB) (defined as OABSS ≥3 with an urgency score of ≥2) in patients with AD was 72.6%. Among the OAB subjects, the most common severity of symptom was moderate (72.6%), followed by mild (21.2%), and severe (5.8%). It was found that OABSS had a very high correlation with aging (r=0.75; p<0.001). When compared with neuropsychological parameters, it was found that OABSS was highly correlated with the CDR scores (r=0.446; p<0.001). However, no significant correlation was found between the changes in OABSS scores and those in other neuropsychological parameters. Based on the individual symptom scores, urgency incontinence was highly correlated with the CDR scores (r=0.43; p<0.001).Conclusions OABSS is a useful tool in assessing AD patients with LUTS. There was a consistent positive association between OABSS severity, including urgency incontinence, and CDR scores.

Efficacy and Safety of Propiverine Chloride Flexible Dose in Female Mixed Urinary Incontinence Patients

Purpose: We investigated the efficacy and safety of propiverine chloride (BUP-4) flexible dose in female patient with mixed urinary incontinence. Methods: The participants were women with mixed incontinence, including urgency (grade 3 or more, one or more episodes per day) or mild stress incontinence (grade I) or both. The subjects were received 4 weeks of treatment with propiverine 20 mg once daily. If the response of the 4 week treatment was insufficient, the dose was increased to 30 mg/day. The patient who satisfied with initial treatment sustained propiverine 20 mg for next 8 weeks. The efficacy of treatment was assessed base on the response of Benefit, Satisfaction and Willingness to Continue questionnaire (BSW questionnaire). Change of Overactive Bladder Symptom Score (OABSS), micturition diary parameters was assessed. Adverse events were evaluated throughout the study. Results: A total of 86 patients with mixed incontinence were enrolled, 76 patients completed the 3 month study. 29 patients (33.7%) responded as “dissatisfied” with the treatment at week 4 and treated with escalated dose to 30 mg propiverine next 8 weeks. (20 mg group; 48 subjects, 30 mg group; 28 subjects) 90% of patients in 30 mg group satisfied with their treatment at final follow-up on week 12. Three patients still dissatisfied with 30 mg propiverine treatment in spite of escalating the dose. The change in OABSS score were significantly improved after 12 week propiverine treatment at both groups. Most clinical parameters showed much more improvement in 20 mg group than 30 mg group. Most common adverse event was dry mouth and constipation. Two patients complained dry mouth, one patient had constipation and two patients had dyspepsia. Conclusions: Propiverine 30 mg could be an effective treatment of mixed incontinence without increasing the incidence of side effect compared to propiverine 20 mg. It could be considered to propiverine 30 mg as a starting dose.

A ureteral stent crossing the bladder midline leads to worse urinary symptoms.

IntroductionTo investigate the correlation between the position of a ureteral stent and stent-related symptoms, excluding the influence of ureteroscopic maneuvers.Material and methodsFrom January 2016 to December 2016, we analyzed 130 patients who placed a ureteral stent before ureteroscopic lithotripsy (URSL). A total of 108 patients were enrolled, including 77 (71.3%) men and 31 (28.7%) women, and the mean age was 58.9 ±14.3 years. On the day before URSL, plain radiography (kidney, ureter, bladder X-ray [KUB]) was used to confirm the stone location and ureteral stent position. According to KUB, we defined the crossing midline group as when the distal loop of the ureteral stent was crossing the bladder midline, and the not crossing midline group as when the distal loop of the ureteral stent was not crossing the bladder midline. We assessed urinary symptoms of the two groups using the overactive bladder symptom score (OABSS) on the day before URSL.ResultsThe crossing midline group had a worse total OABSS (p <0.001) and worse scores for each item of daytime frequency (p = 0.047), nocturia (p <0.001), urgency (p = 0.002), and urgency incontinence (p = 0.045) than did the not crossing group. In multivariate analysis, stent position had the strongest association with the total OABSS (p = 0.002) among the other factors of age, sex, body mass index, stent side, stent diameter, stent length and stent indwelling time.ConclusionsThis study shows that a ureteral stent crossing the bladder midline leads to worse urinary symptoms. Choosing the appropriate stent length for each patient is important for improving stent-related symptoms.

The Effectiveness of Interferential Current on Overactive Bladder Syndrome

Objectives: To determine the effectiveness of interferential current on overactive bladder syndrome. Methodology: It is a quasi-experimental study. The duration of the study is 8 weeks. Total 40 patients were selected for this experimental study from Benazir Bhutto Hospital (BBH) Rawalpindi Pakistan. Sample was drawn through non-probability sampling technique called simple convenient sampling. Standard questionnaire was used for measurement through which results were calculated. Complete information about the patients including their biodata, symptomatology was entered in a Performa and then data was entered on the basis of Overactive Bladder Symptom Score (OABSS) scoring system. A total of 40 patients between the age of 5 to 12 years of age with no gender, religion, or ethnic background differentiation and with the diagnosis of overactive bladder were included. Results: it showed that baseline Mean pyuria was 1.75 ± 0.493 SD and after treatment 1.25 ± 0.439 SD and dysuria baseline mean is 1.78 ± 0.474 SD and after treatment Mean is 1.32 ± 0.423 SD. Hematuria baseline mean is 1.98 ± 0.423 SD and after treatment mean is 1.78 ± 0.158 SD mean frequency of urination is 2.0 ± 0.234 and after treatment mean is 1.2 ± 0.342 bed wetting mean is 1.62 ± 0.423 SD and after treatment mean is 1.22 ± 0.490 SD OABSS Score mean is 2.125 ± 0.334 SD and after treatment mean is 1.55 ± 0.597 SD all values showed significant difference. Conclusion: Interferential Current (IFC) Therapy is a very effective and beneficial tool to improve the symptoms and quality of life of the patients with Hinman syndrome.

Nocturia Improvement With Surgical Correction of Sleep Apnea.

PurposeTo evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA).MethodsA total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment.ResultsThe response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters.ConclusionsOSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.

Urge Urinary Incontinence And Pelvic Organ Prolapse Treatment By Cervicosacropexy (CESA): First Steps In Lithuania

Background. The purpose of our study is to evaluate and present the results of the first cervicosacropexy (CESA) in Lithuania, which was performed in Klaipeda university hospital. Materials and methods. For the 62 years old female patient suffering from overactive bladder syndrome, confirmed by urodynamic test, and II⁰ pelvic organ prolapse (by pelvic organ prolapse quantification classification) cervicosacropexy using polyvinylidene fluoride (PVDF) tape was performed in Klaipeda University Hospital in 2016. Urinary incontinence was evaluated by voiding diary, International Consultation on Incontinence Modular Questionnaire - Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS), that were filled by the patient before the surgery and 2, 4, 8 weeks after it. Urinary urgency, episodes of urinary incontinence, the need of sanitary pads and urinary frequency were compared before and after the surgery. To assess urinary incontinence impact on daily life, the General King‘s Health Questionnaire (GKHQ) was used before and after the procedure. Results. After the surgery decrease of episodes of urinary incontinence, urinary frequency during day and night, urinary urgency and the need of sanitary pads were observed. Moreover, the patient could hold the urine longer after feeling the need to urinate. Scores of ICIQ-SF and OABSS decreased. GKHQ revealed considerable improvement in quality of life after CESA. Social life, mental and physical health of the patient were improved, and sexual life was unchanged. Conclusions. After CESA surgery using PVFD tape, functional indicators and quality of life were improved. First results of this surgery are very good and promising.

Do female patients with predominant voiding symptoms really have objective voiding-phase dysfunction?

ObjectivesTo investigate whether female patients with predominant voiding symptom really have objective voiding phase dysfunction. MethodsFemale patients with lower urinary tract symptoms who underwent video-urodynamic study between January 2009 and December 2012 were recruited. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI-6) questionnaires. The patients with IPSS-voiding subscores greater than IPSS-storage subscores and their most bother symptom are one of voiding symptom of IPSS were defined as subjective voiding dysfunction group (SVD group). The demographics, IPSS scores, OABSS scores, frequency-volume charts and urodynamic variables were compared between SVD and non-SVD groups. ResultsOf the 842 enrolled patients, 142 (16.9%) were classified into SVD group. Total IPSS and IPSS-voiding subscores of SVD group were significantly higher than those of non-SVD group. Conversely, IPSS-storage subscores, OABSS and UDI-6 scores of SVD group were significantly lower than those of non-SVD group. The prevalence of urodynamic voiding phase dysfunction was 64.7% in SVD group, which was significantly higher than those of non-SVD group (37.8%, p < 0.01). SVD group showed more prevalent bladder outlet obstruction (50.0% vs. 27.0%, p < 0.01). There were no significant differences in the prevalence of impaired detrusor contractility between SVD and non-SVD group. Detrusor overactivity was more prevalent in non-SVD group (5.6% vs. 18.6%, p < 0.01). ConclusionsEven though the female patients complain of predominant voiding symptoms, only two thirds of them were identified having urodynamic voiding phase dysfunction. On the other hand, in female patients whose predominant complaint are not voiding symptom, around one third of them were found to have urodynamic voiding phase dysfunction. This study clearly indicates that in females subjective low urinary tract symptoms are not necessarily reliable.

Impact of postoperative phosphodiesterase type 5 inhibitor treatment on lower urinary tract symptoms after robot-assisted radical prostatectomy: a longitudinal study

Objective: This study aimed to assess the role of tadalafil, a phosphodiesterase type 5 inhibitor (PDE5-I), in recovery of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP).Materials and methods: All patients treated with RARP between October 2010 and August 2013 were enrolled in this retrospective study on prospectively collected data. Patients were retrospectively divided into groups according to postoperative treatment: patients taking tadalafil twice weekly from 1 month to 6 months after RARP, and patients not taking tadalafil. The International Prostate Symptom Score (IPSS), the Overactive Bladder Symptom Score (OABSS) and urinary continence (UC) were assessed preoperatively (2 days before RARP) and at 1, 3, 6, 9 and 12 months after RARP.Results: There was no difference in the overall IPSS score between the groups. At 6 and 9 months, the IPSS storage symptom scores were significantly lower in patients taking tadalafil than in patients not taking tadalafil. In patients with overactive bladder (OAB) before RARP (n = 22), no differences in the total scores of OABSS were seen between patients taking tadalafil and patients not taking tadalafil. On the other hand, in non-OAB patients before RARP (n = 68), at 3, 6 and 9 months, the total scores of OABSS were significantly lower in patients taking tadalafil than in patients not taking tadalafil. No differences in UC rates after surgery were seen between the groups.Conclusion: Postoperative tadalafil treatment may be temporarily effective for the recovery of the IPSS storage symptom scores and OABSS.

Tadalafil Improves Symptoms, Erectile Function and Quality of Life in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (KYU-PRO Study).

Effect of tadalafil on lower urinary tract symptoms (LUTS), erectile function and quality of life (QoL) were prospectively evaluated in patients with benign prostatic hyperplasia (BPH) at multicenter. Eligible men were ≥40 years who had no treatment with alpha-blocker for BPH, with total International Prostate Symptom Score (IPSS) ≥8, IPSS-QOL ≥2 and prostate volume ≥20 mL. Data were collected on age, body mass index (BMI), and prostate specific antigen (PSA). Patients were asked to complete a self-reported questionnaire regarding the IPSS, Overactive Bladder Symptom Score (OABSS), International Index of Erectile Function 5 (IIEF5), and Medical Outcome Study 8-Item Short-Form Health Survey (SF-8). These measures were assessed at baseline, 4-, 8-, 12-week of tadalafil treatment. In addition, uroflowmetry was also performed at baseline, and 12-week end point visit. Thirty five patients with mean age 67.3 years, mean BMI 23.6 kg/m2 , mean prostate volume 36 mL, and mean PSA 3.4 ng/mL were enrolled. Treatment with tadalafil significantly improved IPSS total score, IPSS voiding subscore, IPSS storage subscore, OABSS and IPSS-QoL score after 4 weeks and these improvements were maintained for 12-week treatment period. IIEF5 score and general health in SF-8 are significantly improved with the treatment of tadalafil. However, maximum flow rate and postvoiding residual volume were not significantly changed. There were not any serious adverse events. These results indicate that tadalafil 5 mg once daily would be effective and well tolerated treatment in Japanese men with BPH-LUTS.

Treatment Outcome of Overactive Bladder Patients Receiving Antimuscarinic Therapy for More than One Year.

Details on the therapeutic effects of long-term antimuscarinic therapy have not been reported. Thus, the aim of this study is to evaluate the detailed long-term therapeutic effect of antimuscarinic therapy. All consecutive patients who visited the urologic outpatient clinics of a medical center for treatment of overactive bladder syndrome and received antimuscarinic therapy of 12 months or more were retrospectively reviewed. All medical records, including the Overactive Bladder Symptom score (OABSS), the modified Indevus Urgency Severity Scale and the International Prostate Symptoms score (IPSS) questionnaires, and uroflowmetry parameters were reviewed at each visit. A total of 140 patients had received 12 months or more of antimuscarinic therapy. Sustained therapeutic effects were observed by persistent decreases of IPSS-storage score, IPSS-total score and OABSS score. Moreover, the maximum flow rate did not change over time. A temporary increase in postvoid residual volume and decrease in voiding efficiency were found, but these parameters improved over long-term visits. Side-effects were observed in 81 patients (57.9%) and included dry mouth (n = 58, 41.4%), constipation (n = 48, 34.3%) and blurred vision (n = 4, 2.9%); all side-effects were tolerable. Patients aged 75 years or more (n = 94) had a higher comorbidity rate (n = 46, 48.9%) before treatment but generally exhibited similar therapeutic effects as overall patients; elderly patients could also tolerate side-effects. Sustained therapeutic effects were observed in patients who received 12 months or more of antimuscarinic therapy, even in elderly patients. In addition, side-effects in patients receiving long-term therapy were also common but tolerable.

The efficacy of mirabegron additional therapy for lower urinary tract symptoms after treatment with α1-adrenergic receptor blocker monotherapy: prospective analysis of elderly men.

BackgroundMirabegron is a β3-adrenoreceptor agonist developed for treatment of overactive bladder (OAB). α1-Adrenergic receptor blockers are effective for lower urinary tract symptoms (LUTS) in male patients. However, the efficacy of mirabegron additional treatment in elderly male patients with persistent male LUTS, especially in OAB after monotherapy with α1-adrenergic blockers, is not fully understood.MethodsThis study was conducted in male LUTS patients who were ≥ 65 years of age and had persistent OAB symptoms, regardless of whether they took an α1-adrenergic receptor blocker orally. Before and 12 weeks after mirabegron additional therapy (50 mg once daily), we evaluated the efficacy of this treatment using the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS), and changes in the maximum flow rate (Qmax) and post-void residual urine volume (PVR). We evaluated patients overall and divided into two groups by age: young-old (from 65 to 74 years old) and old-old (from 75 to 84 years old).ResultsFifty men were enrolled in this study. Mirabegron additional therapy improved the total OABSS, total IPSS, and IPSS-quality of life (QOL) score. The voided volume (VV) and Qmax improved after treatment in patients overall. However, there was no significant change in PVR. The total OABSS, total IPSS, and IPSS-QOL score significantly improved in both of the young-old and old-old groups. However, a significant increasing of VV was detected in the young-old group. There were no significant differences in the Qmax or PVR in either group.ConclusionsMirabegron additional therapy was effective for male patients whose persistent LUTS and particularly OAB was not controlled with α1-adrenergic receptor blocker monotherapy, and mirabegron did not have negative effects on voiding function. Additionally, mirabegron additional therapy was considered effective regardless of patient age.Trial registrationTrial registration number (TRN) trial registration number (TRN) and date of registration: ISRCTN16759097 in July 8, 2016.